US20070032802A1 - Access and closure device and method - Google Patents

Abstract

Devices and methods for accessing and closing vascular sites are disclosed. Self-sealing closure devices and methods are disclosed. A device that can make a steep and controlled access path into a vascular lumen is disclosed. Methods for using the device are also disclosed.

Description

BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention relates to the field of accessing a biological lumen and closing the access port thereby created.
• 2. Description of the Related Art
• A number of diagnostic and interventional vascular procedures are now performed translumenally, where a catheter is introduced to the vascular system at a convenient access location—such as the femoral, brachial, or subclavian arteries—and guided through the vascular system to a target location to perform therapy or diagnosis. When vascular access is no longer required, the catheter and other vascular access devices must be removed from the vascular entrance and bleeding at the puncture site must be stopped.
• One common approach for providing hemostasis is to apply external force near and upstream from the puncture site, typically by manual compression. This method is time-consuming, frequently requiring one-half hour or more of compression before hemostasis. This procedure is uncomfortable for the patient and frequently requires administering analgesics. Excessive pressure can also present the risk of total occlusion of the blood vessel, resulting in ischemia and/or thrombosis.
• After hemostasis is achieved by manual compression, the patient is required to remain recumbent for six to eighteen hours under observation to assure continued hemostasis. During this time bleeding from the vascular access wound can restart, potentially resulting in major complications. These complications may require blood transfusion and/or surgical intervention.
• Bioabsorbable fasteners have also been used to stop bleeding. Generally, these approaches rely on the placement of a thrombogenic and bioabsorbable material, such as collagen, at the superficial arterial wall over the puncture site. This method generally presents difficulty locating the interface of the overlying tissue and the adventitial surface of the blood vessel. Implanting the fastener too far from the desired location can result in failure to provide hemostasis. If, however, the fastener intrudes into the vascular lumen, thrombus can form on the fastener. Thrombus can embolize downstream and/or block normal blood flow at the thrombus site. Implanted fasteners can also cause infection and auto-immune reactions/rejections of the implant.
• Suturing methods are also used to provide hemostasis after vascular access. The suture-applying device is introduced through the tissue tract with a distal end of the device located at the vascular puncture. Needles in the device draw suture through the blood vessel wall on opposite sides of the punctures, and the suture is secured directly over the adventitial surface of the blood vessel wall to close the vascular access wound.
• To be successful, suturing methods need to be performed with a precise control. The needles need to be properly directed through the blood vessel wall so that the suture is well anchored in tissue to provide for tight closure. Suturing methods also require additional steps for the surgeon.
• Due to the deficiencies of the above methods and devices, a need exists for a more reliable vascular closure method and device. There also exists a need for a vascular closure device and method that does not implant a foreign substance and is self-sealing. There also exists a need for a vascular closure device and method requiring no or few extra steps to close the vascular site.
BRIEF SUMMARY OF THE INVENTION
• A device for accessing a biological lumen is disclosed. The biological lumen has a lumen wall having a longitudinal lumen wall axis. The device has an elongated member that has a longitudinal member axis. The member is configured to access the lumen at a first angle. The first angle is defined by the longitudinal lumen wall axis and the longitudinal member axis. The first angle is less than about 19 degrees.
• The first angle can be less than about 15 degrees. The first angle can be less than about 10 degrees. The device can also have an anchor. The anchor can be configured to hold the elongated member at a fixed angle with respect to the longitudinal lumen wall axis.
• The device can also have a retainer. The retainer can be configured to hold the elongated member at a fixed angle with respect to the longitudinal lumen axis.
• Another device for accessing a biological lumen is disclosed. The biological lumen has a lumen wall and a longitudinal lumen wall axis. The device has a first elongated member and a second elongated member. The first elongated member has a first elongated member axis. The second elongated member has a second elongated member axis. The second elongated member is configured so that the second elongated member axis is parallel to the longitudinal lumen wall axis.
• The second elongated member can have a retainer. The retainer can have an inflatable member. The retainer can have a resilient member. The second elongated member can extend substantially adjacent to the lumen wall.
• Also disclosed is a device for closing an opening on a biological lumen wall. The device has a longitudinal axis, a first force-applying member, a second force-applying member, and a resilient member. The resilient member provides to the first and the second force-applying members a force that is radially outward with respect to the longitudinal axis.
• A method of accessing a blood vessel through a blood vessel wall is also disclosed. The blood vessel wall has a longitudinal wall axis. The method includes entering the vessel at an angle of less than about 19 degrees with respect to the longitudinal wall axis. The method also includes inserting a lumenal tool into the vessel.
• Also disclosed is a method for accessing a biological lumen. The biological lumen has a lumen wall and a longitudinal lumen wall axis. The method includes inserting in the biological lumen a second elongated member. The second elongated member has a second elongated member axis. The method also includes aligning the second elongated member so that the second elongated member axis is substantially parallel to the longitudinal lumen wall axis. Further, the method includes inserting in the biological lumen a first elongated member comprising a first elongated member axis.
• Additionally disclosed is a method of closing a vascular opening. The vascular opening has an inside surface and a longitudinal axis. The method includes inserting a device in the opening and applying a force to the inside surface. The force is directed in at least one radially outward direction from the longitudinal axis.
• The method can include maintaining the force. The applying a force can include the device applying at least a part of the force. The applying of a force can include the device applying all of the force.
• Also disclosed is a method for accessing and closing a blood vessel having a vessel wall. The vessel wall can have an inside surface and an outside surface. The method includes forming an arteriotomy and deploying a closure augmentation device in the arteriotomy. The closure augmentation device produces pressure on the inside surface and the outside surface.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a front perspective view of an embodiment of the arteriotomy device.
• FIG. 2 is a side view of the arteriotomy device ofFIG. 1.
• FIG. 3 is a close-up view of the arteriotomy device ofFIG. 1.
• FIGS. 4 and 5 are close-up views of various embodiments of the anchor.
• FIG. 6 is a side perspective view of an embodiment of the arteriotomy device with the introduction device deployed.
• FIG. 7 is a close-up view of an embodiment of the arteriotomy device with the introduction device deployed.
• FIGS. 8 and 9 are side views of various embodiments of the arteriotomy device with the introduction devices deployed.
• FIG. 10 is a bottom perspective view of an embodiment of the arteriotomy device.
• FIG. 11 is a side view of an embodiment of the arteriotomy device with the lumenal retainer deployed.
• FIG. 12 is a bottom perspective view of an embodiment of the arteriotomy device with the lumenal retainer deployed.
• FIG. 13 is a side perspective view of an embodiment of the arteriotomy device.
• FIG. 14 is a side perspective view of an embodiment of the arteriotomy device with the entry wall retainer deployed.
• FIGS. 15 and 16 illustrate various embodiments of the tensioner.
• FIGS. 17 and 18 illustrate various embodiments of the pressure clip.
• FIGS. 19 and 20 illustrate various embodiments of the toggle.
• FIG. 21 illustrates a method for deploying the arteriotomy device in a cross-section of a lumen.
• FIGS. 22 and 23 illustrate methods for deploying the retainers in a cross-section of a lumen.
• FIGS. 24 and 25 illustrate a method for deploying the introduction device in a cross-section of a lumen.
• FIG. 26 illustrates a method for deploying a guidewire in a cross-section of a lumen.
• FIGS. 27-30 illustrate a method for deploying the introduction device in a cross-section of a lumen.
• FIG. 31 illustrates a method for deploying a guidewire in a cross-section of a lumen.
• FIG. 32 illustrates a portion of an arteriotomized lumen.
• FIG. 33 illustrates section A-A ofFIG. 28.
• FIGS. 34-36 illustrate a method for deploying a tensioner in a see-through portion of lumen wall.
• FIGS. 37-40 illustrate methods for deploying various embodiments of the pressure clip in a cross-section of a lumen.
• FIG. 41 illustrates a method of using a suture on a portion of an arteriotomized lumen.
• FIG. 42 illustrates section B-B ofFIG. 41 with the out-of-section suture.
• FIG. 43 illustrates a method of using pledgets on a portion of an arteriotomized lumen.
• FIG. 44 illustrates section C-C ofFIG. 43.
• FIG. 45 illustrates an embodiment of the toggle deployment device in a first configuration.
• FIG. 46 is a close-up view ofFIG. 45.
• FIG. 47 illustrates an embodiment of the toggle deployment device in a second configuration.
• FIG. 48 is a close-up view ofFIG. 47.
• FIG. 49 illustrates a method of using the toggle deployment device in a cross-section of a lumen.
• FIG. 50 illustratesFIG. 49 with a portion of the toggle deployment device shown in section D-D.
• FIG. 51 illustrates a method of using the toggle deployment device in a cross-section of a lumen.
• FIG. 52 illustratesFIG. 51 with a portion of the toggle deployment device shown in section E-E.
• FIGS. 53-55 illustrate a method of using the toggle deployment device in a cross-section of a lumen.
• FIG. 56 is a close-up view ofFIG. 55.
• FIG. 57 illustrates an embodiment of a deployed toggle in a cross-section of a lumen.
• FIG. 58 is a close-up view ofFIG. 59.
• FIGS. 59-61 illustrate a method for deploying a toggle in a cross-section of a lumen.
• FIG. 62 is a close-up view ofFIG. 61.
• FIG. 63 illustrates a method for deploying a toggle in a cross-section of a lumen.
• FIGS. 64-66 shown, in cross-section, a method for deploying the guidewire through an arteriotomy.
• FIGS. 67 and 68 illustrate a method for attaching guidewire to the anchor.
DETAILED DESCRIPTION
• FIGS. 1 through 3 illustrate a device for accessing a biological lumen, such as anarteriotomy device2. Thearteriotomy device2 can have adelivery guide4. Thedelivery guide4 can be slidably attached to ananchor6. Theanchor6 can be rigid, flexible or combinations thereof. Theanchor6 can be resilient, deformable or combinations thereof. Theanchor6 can be retractable and extendable from thedelivery guide4. Thedelivery guide4 can have anintroducer lumen8. Theintroducer lumen8 can have an introducerlumen exit port10. The introducerlumen exit port10 can be on the surface of thedelivery guide4.
• Theanchor6 can have ananchor angle section12. Theanchor6 can have ananchor extension section14, for example a guide eye sheath or an attachable guidewire. Theanchor extension section14 can extend from theanchor angle section12. Theanchor extension section14 can be separate from and attached to, or integral with, theanchor angle section12.
• Theanchor angle section12 can have an anchor anglefirst sub-section16, ananchor bend20 and an anchor anglesecond sub-section18. The anchor angle first and/orsecond sub-sections16 and/or18 can be part of theanchor bend20. Theanchor bend20 can have a sharp or gradual curve. The radius of curvature for theanchor bend20 can be from about 0.1 mm (0.004 in.) to about 2.0 mm (0.079 in.).
• The anchor anglefirst sub-section16 can have an anchor anglefirst sub-section diameter22 from about 0.38 mm (0.015 in.) to about 1.0 mm (0.039 in.), for example about 0.71 mm (0.028 in.). The anchor anglesecond sub-section18 can have an anchor anglesecond sub-section diameter24 from about 0.38 mm (0.015 in.) to about 1.0 mm (0.039 in.), for example about 0.71 mm (0.028 in.).
• The anchor anglefirst sub-section16 can have a deliverylongitudinal axis26. The anchor anglesecond sub-section18 can have an anchorlongitudinal axis28. The intersection of the deliverylongitudinal axis26 and the anchorlongitudinal axis28 can be an anchoringangle30. The anchoringangle30 can be from about 20° to about 90°, more narrowly from about 30° to about 60°, for example about 45°.
• Any or all elements of thearteriotomy device2 or other devices or apparatuses described herein can be made from, for example, a single or multiple stainless steel alloys, nickel titanium alloys (e.g., Nitinol), cobalt-chrome alloys (e.g., ELGILOY® from Elgin Specialty Metals, Elgin, Ill.; CONICHROME® from Carpenter Metals Corp., Wyomissing, Pa.), molybdenum alloys (e.g., molybdenum TZM alloy, for example as disclosed in International Pub. No. WO 03/082363 A2, published 9 Oct. 2003, which is herein incorporated by reference in its entirety), tungsten-rhenium alloys, for example, as disclosed in International Pub. No. WO 03/082363, polymers such as polyester (e.g., DACRON® from E. I. Du Pont de Nemours and Company, Wilmington, Del.), polypropylene, polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyether ether ketone (PEEK), nylon, polyether-block co-polyamide polymers (e.g., PEBAX® from ATOFINA, Paris, France), aliphatic polyether polyurethanes (e.g., TECOFLEX® from Thermedics Polymer Products, Wilmington, Mass.), polyvinyl chloride (PVC), polyurethane, thermoplastic, fluorinated ethylene propylene (FEP), absorbable or resorbable polymers such as polyglycolic acid (PGA), polylactic acid (PLA), polydioxanone, and pseudo-polyamino tyrosine-based acids, extruded collagen, silicone, zinc, echogenic, radioactive, radiopaque materials or combinations thereof. Examples of radiopaque materials are barium sulfate, zinc oxide, titanium, stainless steel, nickel-titanium alloys, tantalum and gold.
• Any or all elements of thearteriotomy device2, including supplemental closure devices, such as tensioners, clips, toggles, sutures, or other devices or apparatuses described herein can be or have a matrix for cell ingrowth or used with a fabric, for example a covering (not shown) that acts as a matrix for cell ingrowth. The matrix and/or fabric can be, for example, polyester (e.g., DACRON® from E. I. du Pont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE, ePTFE, nylon, extruded collagen, silicone or combinations thereof.
• The elements of thearteriotomy device2 and/or the fabric can be filled and/or coated with an agent delivery matrix known to one having ordinary skill in the art and/or a therapeutic and/or diagnostic agent. The agents within these matrices can include radioactive materials; radiopaque materials; cytogenic agents; cytotoxic agents; cytostatic agents; thrombogenic agents, for example polyurethane, cellulose acetate polymer mixed with bismuth trioxide, and ethylene vinyl alcohol; lubricious, hydrophilic materials; phosphor cholene; anti-inflammatory agents, for example non-steroidal anti-inflammatories (NSAIDs) such as cyclooxygenase-1 (COX-1) inhibitors (e.g., acetylsalicylic acid, for example ASPIRIN® from Bayer AG, Leverkusen, Germany; ibuprofen, for example ADVIL® from Wyeth, Collegeville, Pa.; indomethacin; mefenamic acid), COX-2 inhibitors (e.g., YIOXX® from Merck & Co., Inc., Whitehouse Station, N.J.; CELEBREX® from Pharmacia Corp., Peapack, N.J.; COX-1 inhibitors); immunosuppressive agents, for example Sirolimus (RAPAMUNE®, from Wyeth, Collegeville, Pa.), or matrix metalloproteinase (MMP) inhibitors (e.g., tetracycline and tetracycline derivatives) that act early within the pathways of an inflammatory response. Examples of other agents are provided in Walton et al, Inhibition of Prostoglandin E₂Synthesis in Abdominal Aortic Aneurysms,Circulation, Jul.6, 1999, 48-54; Tambiah et al, Provocation of Experimental Aortic Inflammation Mediators andChlamydia Pneumoniae, Brit. J. Surgery88 (7), 935-940; Franklin et al, Uptake of Tetracycline by Aortic Aneurysm Wall and Its Effect on Inflammation and Proteolysis,Brit. J. Surgery86 (6), 771-775; Xu et al, Sp1 Increases Expression of Cyclooxygenase-2 in Hypoxic Vascular Endothelium,J. Biological Chemistry275 (32) 24583-24589; and Pyo et al, Targeted Gene Disruption of Matrix Metalloproteinase-9 (Gelatinase B) Suppresses Development of Experimental Abdominal Aortic Aneurysms, J Clinical Investigation 105 (11), 1641-1649 which are all incorporated by reference in their entireties.
• FIG. 4 illustrates that theanchor angle section12 and theanchor extension section14 can have a flexible elongated element. The flexible elongated element can be resilient and/or deformable. The flexible elongated element can have an integral, or multiple separate and fixedly attached,wound wire32. Theanchor angle section12 can be in asheath34.FIG. 5 illustrates that theanchor angle section12 can have awire coating36, for example a lubricious coating and/or a coating made from urethane.
• FIGS. 6 and 7 illustrate that thearteriotomy device2 can have anintroduction device38. Theintroduction device38 can be slidably attached to theintroducer lumen8. Theintroduction device38 can have a hollow needle (as shown inFIG. 6). Theintroduction device38 can have a solid needle (as shown inFIG. 7). Theintroduction device38 can have a guidewire.
• Theintroduction device38 can have an introductionlongitudinal axis40. The intersection of the introductionlongitudinal axis40 and the anchorlongitudinal axis28 can be anintroduction angle42. Theintroduction angle42 can be less than or equal to about 19°, more narrowly less than or equal to about 15°, yet more narrowly from about 5° to about 10°, for example about °10.
• Theintroduction device38 can have anintroduction device diameter44. Theintroduction device diameter44 can be from about 0.25 mm (0.010 in.) to about 1.0 mm (0.039 in.), for example about 0.56 mm (0.022 in.).
• FIGS. 8 and 9 illustrate that thearteriotomy device2 can be configured so that theintroduction device38 can be deployed from theanchor6. Theanchor6 can have anintroduction device port46. Theintroduction device38 can be a hollow needle (as shown inFIG. 8). When fully deployed, theintroduction device38 can contact the introducerlumen exit port10. Theintroduction device38 can be a channel between theintroducer lumen8 and theanchor6. Theanchor6 can have a port (not shown) configured to communicate with the biological lumen and theintroduction device38. Theintroduction device38 can be a solid needle (as shown inFIG. 9).
• FIG. 10 illustrates that alumenal retainer48 can have a first retracted configuration. Thelumenal retainer48 can be seated in alumenal retainer port50. Thelumenal retainer port50 can be in theanchor6. Thelumenal retainer48 can be a wire, scaffold or stent—for example made from a deformable or resilient material, such as a shape memory alloy—an inflatable balloon, or combinations thereof. Intralumenal inflatable balloons, such as those inflated with saline solution or carbon dioxide, are known to those having ordinary skill in the art. Thelumenal retainer48 can extend into thedelivery guide4.
• FIGS. 11 and 12 illustrate that thelumenal retainer48 can have a second deployed configuration.FIG. 11 shows that thelumenal retainer48 can be a wire or balloon.FIG. 12 shows that thelumenal retainer48 can be a wire. In the deployed configuration, thelumenal retainer48 can deploy away from the lumenal retainer port. Thelumenal retainer48 can have a lumenal retainer deployeddiameter52. The lumenal retainer deployeddiameter52 can be from about 2.54 mm (0.100 in.) to about 10.2 mm (0.400 in.), for example about 6.35 mm (0.250 in.).
• FIG. 13 illustrates that thearteriotomy device2 can have an entrywall retainer port54. The entrywall retainer port54 can be at or near theanchor bend20. The entrywall retainer port54 can be at or near the anchor anglefirst sub-section16. The entrywall retainer port54 can be in fluid communication with a sensor or port (not shown) on or near thedelivery guide4 of thearteriotomy device2.
• FIG. 14 illustrates that anentry wall retainer56 can be deployed through the entrywall retainer port54. Theentry wall retainer56 can have a first retracted configuration (as shown inFIG. 13). Theentry wall retainer56 can have a second deployed configuration (as shown inFIG. 14).
• FIGS. 15 through 20 illustrate various supplemental closure devices. The supplemental closure devices can be completely or partially bioabsorbable, bioresorbable, bioadsorbable or combinations thereof. The supplemental closure devices can be made from homografts, heterografts or combinations thereof. The supplemental closure devices can be made from autografts, allografts or combinations thereof.
• FIG. 15 illustrates atensioner58. Thetensioner58 can be resilient, deformable, or combinations thereof. Thetensioner58 can have a tensionerlongitudinal axis60. Thetensioner58 can have a resilient element, such as a spring, for example atensioner head62. Thetensioner head62 can have a tensionerfirst shoulder64. Thetensioner head62 can have a tensionersecond shoulder66. The tensioner first andsecond shoulders64 and66 can rotatably attached to a separate or integral tensionerfirst leg68 and a separate or integral tensionersecond leg70, respectively. The tensioner first andsecond legs68 and70 can attach to tensioner first andsecond feet72 and74, respectively.
• Thetensioner legs68 and70 can havetensioner leg diameters76. Thetensioner leg diameters76 can be from about 0.1 mm (0.005 in.) to about 0.76 mm (0.030 in.), for example about 0.38 mm (0.015 in.). The tensioner first andsecond legs68 and70 can have a tensioner inter-legouter diameter78. The tensioner inter-legouter diameter78 can be from about 1.3 mm (0.050 in.) to about 5.08 mm (0.200 in.), for example about 4.06 mm (0.160 in.). The tensioner shoulders64 and/or66 and/or thetensioner feet72 and/or74 can extend to a greater radius from the tensionerlongitudinal axis60 than their respective tensioner inter-leg radius.
• FIG. 16 illustrates a tensionerfirst strut80 that can attach to the tensionerfirst leg68 and the tensionersecond leg70. The tensionerfirst leg68 can be resilient, deformable or combinations thereof. A tensionersecond strut82 can attach to the tensionerfirst leg68 and the tensionersecond leg70. The tensionersecond leg70 can be resilient and/or deformable. Thetensioner58 can have notensioner head62. Thetensioner58 can have more than two tensioner struts80 and82.
• FIG. 17 illustrates apressure clip84. Thepressure clip84 can be resilient. Thepressure clip84 can be deformable. Thepressure clip84 can have a pressure cliplongitudinal axis86. Thepressure clip84 can have a pressure,clip head88. The pressure clip head.88 can be rotatably attached to a separate or integral pressure clipfirst leg90. Thepressure clip head88 can be rotatably attached to a separate or integral pressure clipsecond leg92. The pressure clip can have a pressure clipfirst end94 and a pressure clipsecond end96. The pressure clipfirst leg90 can terminate in the pressure clipfirst end94. The pressure clipsecond leg92 can terminate in the pressure clipsecond end96. The pressure clipfirst leg90 and/or the pressure clipsecond leg92 can be biased toward the pressure cliplongitudinal axis86.
• FIG. 18 illustrates thepressure clip84 that can have apressure clip sheath98 slidably attached to the pressure clipsecond leg92. The pressure clip first, and/or second ends94 and/or96 can be pressure dissipaters, such as flat and/or curved portions, for example circular loops. The pressure clip first and/or second ends94 and/or96 can be resilient and/or deformable. The pressure clipfirst leg90 can be rotatably attached to the pressure clipsecond leg92. The pressure clipfirst leg90 can be attached to the pressure clipsecond leg92 via a rotatable, and/or deformable, and/or flexural joint in thepressure clip head88.
• FIG. 19 illustrates atoggle100. Thetoggle100 can have a togglefirst end102. Thetoggle100 can have a togglesecond end104. The toggle first and/or second ends102 and/or104 can be bars, dowels, rods, beams, or combinations thereof. Thetoggle100 can have afilament106. Thefilament106 can be fixedly attached at a filamentfirst end107 to the togglefirst end102. Thefilament106 can be fixedly attached at a filamentsecond end109 to the togglesecond end104. Thefilament106 can be resilient or deformable. Thefilament106 can be substantially flexible.
• FIG. 20 illustrates thetoggle100 that can have thefilament106 that can be slidably attached to the togglesecond end104 at ahole108. Thefilament106 can frictionally fit thehole108. Thefilament106 can have no pawls110 (not shown inFIG. 20). Thefilament106 can interference fit thehole108. Thefilament106 can have one or more pawls110. Thehole108 can have one ormore notches112. Thenotches112 can be internal to thehole108. Thenotches112 and thepawls110 can be configured to allow the togglesecond end104 to slide toward the togglefirst end102. Thenotches112 and thepawls110 can be configured to provide an interference fit when the togglesecond end104 is attempted to be moved away from the togglefirst end102.
• Method of Manufacture
• The elements of thearteriotomy device2, including the supplemental closure devices, can be directly attached by, for example, melting, screwing, gluing, welding or use of an interference fit or pressure fit such as crimping, snapping, or combining methods thereof. The elements can be integrated, for example, molding, die cutting, laser cutting, electrical discharge machining (EDM) or stamping from a single piece or material. Any other methods can be used as known to those having ordinary skill in the art.
• Integrated parts can be made from pre-formed resilient materials, for example resilient alloys (e.g., Nitinol, ELGILOY® that are preformed and biased into the post-deployment shape and then compressed into the deployment shape as known to those having ordinary skill in the art
• Any elements of thearteriotomy device2, including the supplemental closure devices, or thearteriotomy device2, including the supplemental closure devices, as a whole after assembly, can be coated by dip-coating, brush-coating or spray-coating methods known to one having ordinary skill in the art For example, these methods can be used to coat thewound wire32 with thewire coating36 can be spray coated, dip-coated or brushed onto thewire32.
• One example of a method used to coat a medical device for vascular use is provided in U.S. Pat. No. 6,358,556 by Ding et al. and hereby incorporated by reference in its entirety. Time release coating methods known to one having ordinary skill in the art can also be used to delay the release of an agent in the coating, for example the coatings on the supplemental closure devices.
• The supplemental closure devices can be covered with a fabric, for example polyester (e.g., DACRON® from E. I. du Pont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE, ePTFE, nylon, extruded collagen, silicone or combinations7 thereof. Methods of covering an implantable device with fabric are known to those having ordinary skill in the art.
• Method of Use
• FIG. 21 illustrates a method of inserting theanchor6 into abiological lumen114, for example a blood vessel, such as a femoral artery. Thebiological lumen114 can have alumen wall116 and alumen wall surface118. Theanchor6 can be inserted into thebiological lumen114 using a Seldinger technique, modified Seldinger technique, or other method known to one having ordinary skill in the art. Theanchor6 can create afirst arteriotomy120. Theanchor6 can be inserted into thelumen114 so that the anchor anglesecond sub-section18 can be substantially parallel with thelumen wall surface118. Theanchor6 can be inserted into thelumen114 so that the anchor anglesecond sub-section18 can be substantially in contact with thelumen wall surface118.
• FIG. 22 illustrates a method of deploying, as shown by arrow, thelumenal retainer48 from the first retracted configuration to the second deployed configuration. Thelumenal retainer48 can be deployed by extending a wire, scaffold or stent, or by inflating a balloon. When thelumenal retainer48 is deployed, the anchor anglesecond sub-section18 can be made substantially parallel with thelumen wall surface118. When thelumenal retainer48 is deployed, the anchor anglesecond sub-section18 can be made to be substantially in contact with thelumen wall surface118.
• FIG. 23 illustrates a method of deploying, as shown byarrow122, theentry wall retainer56 from the first retracted configuration to the second deployed configuration. When the lumenal retainer is in the second deployed configuration, thelumenal retainer48 can be substantially parallel with thelumen wall surface118. When the lumenal retainer is in the second deployed configuration, thelumenal retainer48 can be substantially in contact with thelumen wall surface118.
• A proximal force, as shown byarrow124, can be applied to theanchor6, for example by being applied to thedelivery guide4. When the proximal force is applied, the anchor anglesecond sub-section18 can be made substantially parallel with thelumen wall surface118. When the proximal force is applied, the anchor anglesecond sub-section18 can be made to be substantially in contact with thelumen wall surface118.
• FIGS. 24 and 25 illustrate a method for deploying theintroduction device38. Theintroduction device38 can egress from theintroducer lumen8 and the introducerlumen exit port10. As shown inFIG. 24, theintroduction device38 can be pushed, as shown by arrow, into and through thelumen wall116. Theintroduction device38 can form asecond arteriotomy128. As shown inFIG. 25, theintroduction device38 can be pushed, as shown by arrow, adjacent to or through theanchor6. Theanchor6 can be configured to have ports suitable to allow theintroduction device38 to pass through theanchor6. A tip of theintroduction device38 can enter thelumen114.
• Theintroduction device38 can pass through anintroduction run132 and anintroduction rise134. Theintroduction run132 can be the component of the length of theintroduction device38 in thelumen wall116 that is parallel to thelumen wall116. Theintroduction run132 can be the component of the length parallel to thelumen wall116 between the opening of thesecond arteriotomy128 on the outside of thelumen wall116 and the opening of thesecond arteriotomy128 on the insidelumen wall surface118. Theintroduction run132 can be from about 0.10 cm (0.010 in.) to about 3.810 cm (1.500 in.), for example about 0.64 cm (0.25 in.).
• The introduction rise134 can be the component of the length of theintroduction device38 in thelumen wall116 that is perpendicular to thelumen wall116. The introduction rise134 can be the component of the length perpendicular to thelumen wall116 between the opening of thesecond arteriotomy128 on the outside of thelumen wall116 and the opening of thesecond arteriotomy128 on the insidelumen wall surface118. The introduction rise134 can be from about 0.51 mm (0.020 in.) to about 5.08 mm (0.200 in.), for example about 1.0 mm (0.040 in.). An introduction slope can be the ratio of the introduction rise134 to theintroduction run132. The introduction slope can be from about ½ to about 1/40 or less, for example about ⅙, also for example about ⅓. The introduction slope can be, for examples, equal to or less than about ½ or ⅓, more narrowly equal to or less than about ⅓ or ¼, yet more narrowly equal to or less than about ⅕ or ⅙, even still more narrowly than about equal to or less than about 1/10.
• The introduction rise134 and theintroduction run132 can be components of an introduction vector. Theintroduction run132 can be the component of the introduction vector parallel to thelumen wall116. The introduction rise134 can be the component of the introduction vector perpendicular to thelumen wall116. The introduction vector can be a vector from anouter opening136 to aninner opening138. Theouter opening136 can be a temporary or permanent opening on the outside of thelumen wall116 formed by theintroduction device38. Theinner opening138 can be a temporary or permanent opening on the inside of the vessel wall.
• FIG. 26 illustrates that the introduction-device38, for example a hollow needle, can act as a pathway for a lumenal tool, for example tools such as aguidewire168, to be deployed, as shown by arrow, into thelumen114. Theintroduction device38, for example a solid needle, can be removed from thesecond arteriotomy128 and the lumenal tool can be deployed through, for example, the introducerlumen exit port10, and thesecond arteriotomy128. Theintroduction device38 can be the lumenal tool, for example a guidewire. Theintroduction device38 can be further deployed and used as a lumenal tool after passing through thelumen wall116.
• FIGS. 27 through 30 illustrates a method of deploying theintroduction device38 that can have a pre-formed bend. As shown inFIG. 27, thearteriotomy device2 can be configured to deploy theintroduction device38 at theintroduction angle42 from about 0° to about 5°, for example about 0°.
• As shown inFIG. 28, theintroduction device38 can be pushed, as shown by arrow, through thelumen wall116. Theintroduction device38 can cleave a plane in thelumen wall116. The plane can be substantially parallel with thelumen wall surface118. Theintroduction device38 can be adjacent to the adventitia in a blood vessel. Theintroduction device38 can be advanced along the subintimal or submedial cleavage plane in a blood vessel. Once the lumen wall has been cleaved, a subintimal angioplasty can be performed as known to one having ordinary skill in the art. Once the lumen wall has been cleaved, a remote endarterectomy can be performed as known to one having ordinary skill in the art. Bent andstraight introduction devices38 can be swapped during use to selectively cleave thelumen wall116. Tools, such as guidewires, can be inserted throughhollow introduction devices38 to selectively cleave thelumen wall116.
• As shown inFIG. 29, when the bend in theintroduction device38 moves into the lumen wall.116, theintroduction device38 can rotate, as shown by arrow, toward thebiological lumen114. As shown inFIG. 30, the bend in theintroduction device38 can continue to rotate theintroduction device38 toward thebiological lumen114. As described infra, theintroduction device38 can enter thelumen114.FIG. 31 illustrates that theintroduction device38 that can have the bend can act as a pathway for a lumenal tool, as described infra.
• An introducer sheath can be inserted over theguidewire168 and/or theintroduction device38. The introducer sheath can be less than about 22 French (7.3 mm, 0.29 in. diameter) or less than the diameter of the lumen to which the introducer sheath is introduced. The introducer sheath can be, for examples, about 6 French (2.3 mm, 0.092 in. diameter), and about 8 French (2.67 mm, 0.105 in. diameter). The introducer sheath can be known to one having ordinary skill in the art, for example the introducer sheath described in U.S. Pat. No. 5,183,464 to Dubrul, et al.
• The introducer sheath can be inserted into thesecond arteriotomy128. The introducer sheath can expand thesecond arteriotomy128 to a workable size. The introducer sheath can be inserted into thesecond arteriotomy128 before and/or after and/or concurrently with the supplemental closure device is deployed and/or other closure method is used.
• FIGS. 32 and 33 illustrate an exemplarybiological lumen114 after thearteriotomy device2 has been deployed to, and removed from, thebiological lumen114. Thebiological lumen114 can have the first andsecond arteriotomies120 and128. Thebiological lumen114 can have asecond arteriotomy128. Thebiological lumen114 can have afirst web140 on one side of the arteriotomy (shown for the second arteriotomy128), and asecond web142 on the opposite side of thearteriotomy120 or128. The natural pressure, shown by arrows, from the first andsecond webs140 and142 can self-seal thearteriotomy120 or128.
• One or more supplemental closure devices can be deployed to the first and/orsecond arteriotomies120 and/or128. The supplemental closure devices can provide a force or restraint to aid hemostasis. The supplemental closure devices can be permanently or temporarily deployed. The supplemental closure devices can biodissolve after hemostasis is achieved and/or after therelevant arteriotomy120 or128 is substantially or completely healed. The force from the supplemental closure device can be maintained from about 15 minutes to about 24 hours or more, for example about 120 minutes.
• FIG. 34 illustrates atensioner58 in a compressed configuration. Compressive forces, shown by arrows, can compress the tensioner first andsecond legs68 and70. In a compressed configuration, the tensioner inter-legouter diameter78 can be from about 0.51 mm (0.020 in.) to about 2.54 mm (0.100 in.), for example about 1.5 mm (0.060 in.).
• FIGS. 35 and 36 illustrate a method of deploying thetensioner58. As shown inFIG. 35, thetensioner58 can be in a compressed configuration. Thetensioner58 can be exposed to the compressive forces, as shown byarrows144. The compressive forces can be applied by a retractable sheath, clamps, other methods known to one having ordinary skill in the art, or combinations thereof. A deployment force, shown byarrow146, can deploy thetensioner58 into thearteriotomy120 or128.
• Thearteriotomy120 or128 can have anarteriotomy diameter148. Thearteriotomy diameter148 can be from about 0.5 mm (0.020 in.) to about 400 mm (15 in.), yet a narrower range from about 1.0 mm (0.040 in.) to about 10.2 mm (0.400 in.), for example about 2.54 mm (0.100 in.). When in the compressed configuration, the tensioner inter-legouter diameter78 can be smaller than thearteriotomy diameter148. The tensioner first andsecond shoulders64 and66 can be wide enough to interference fit with thearteriotomy120 or128. The tensioner first andsecond shoulders64 and66 can dissipate force on thelumen wall surface118.
• As shown inFIG. 36, the compressive forces can be removed from thetensioner58. The tensioner first andsecond leg68 and70 can expand, as shown by arrows. Thetensioner58 can force thearteriotomy120 or128 into a substantially or completely flat and/or closed and/or stretched configuration. The walls of thearteriotomy120 or128 can come into close contact.
• Thearteriotomy120 or128 can have anarteriotomy width150 and anarteriotomy height152. Thearteriotomy width150 can be about half the circumference of thearteriotomy120 or128. Thearteriotomy width150 can be from about 1.0 mm (0.040 in.) to about 10.2 mm (0.400 in.), for example about 4.06 mm (0.160 in.).
• Thearteriotomy height152 can be about thetensioner leg diameter76. Thearteriotomy height152 can be less than about 0.51 mm (0.020 in.), more narrowly, less than about 0.38 mm (0.015 in.); Thearteriotomy height152 can be from about 0.25 mm (0.010 in.) to about 1.3 mm (0.050 in.), for example about 0.38 mm (0.015 in.). Thearteriotomy height152 can be small enough to enable cell growth, blood clotting, acoustic sealing, heat sealing, gluing, enhanced self-sealing and combinations thereof across thearteriotomy120 or128.
• The tensioner first andsecond shoulders64 and66 can be wide enough to interference fit with thearteriotomy120 or128. The tensioner first andsecond feet72 and74 can be wide enough to interference fit with thearteriotomy120 or128. The tensioner first andsecond feet72 and74 can dissipate force on thelumen wall surface118.
• Thearteriotomy120 or128 can be plugged, and/or packed, and/or tamponed before, and/or concurrent with, and/or after using any of any of the supplemental closure devices infra and/or supra, the self-sealing closure method, or combinations thereof. The plug, pack, tampon, or combinations thereof (not shown) can be made from gelfoam, collagen, other implantable and biocompatible tampon materials known to those having ordinary skill in the art, or combinations thereof.
• FIGS. 37 through 40 illustrate deploying thepressure clip84 to thearteriotomy120 or128.FIG. 37 illustrates extending, and/or thinning, and/or straightening, and/or tensioning the pressure clipsecond end96. Thepressure clip sheath98 can be translated, as shown by arrow, along the pressure clipsecond leg92 and onto the pressure clipsecond end96. Thepressure clip84 can be deployed to the arteriotomy after the pressure clipsecond end96 is extended, and/or thinned, and/or straightened, and/or tensioned.
• As shown inFIG. 38, the pressure clipsecond leg92 can be rotated with respect to thepressure clip head88, so that the pressure clipsecond leg92 and thepressure clip head88 are substantially aligned. The pressure clipsecond leg92 can be deployed, as shown by the arrow, through thefirst arteriotomy120. The pressure clipsecond leg92 can be deployed through the lumen wall116 (e.g., if there is no existingfirst arteriotomy120, if thefirst arteriotomy120 is not suitably located with respect to the second arteriotomy128).
• FIG. 39 illustrates contracting, and/or widening, and/or releasing and/or relaxing the pressure clipsecond end96. Thepressure clip sheath98 can be translated, as shown by arrow, along the pressure clipsecond leg92 and off of the pressure clipsecond end96. The pressure clipsecond end96 can be contracted, and/or widened, and/or released and/or relaxed after thepressure clip84 is deployed to the arteriotomy.
• As shown inFIG. 40, after the pressure clipsecond leg92 is deployed through thefirst arteriotomy120, the pressure clipsecond leg92 can be released or deformed so as to rotate with respect to thepressure clip head88. Thepressure clip head88 can seat in thefirst arteriotomy120. The pressure clip first andsecond legs90 and92 can apply force, as shown by arrows, to the first andsecond webs140 and142, respectively.
• FIGS. 41 and 42 illustrate a method of deploying astitch154 surrounding and/or through thearteriotomy120 or128. Thestitch154 can be tightened to apply additional pressure to thearteriotomy120 or128. Thestitch154 can have aknot156, or other tying configuration or device, for example a pledget or clamp.
• FIGS. 43 and 44 illustrate a method of deploying thefilament106 adjacent to and/or through thearteriotomy120 or128. Thefilament106 can be attached to afirst pledget158aby afirst knot156aor other tying configuration or device. Thefilament106 can be attached to asecond pledget158bby asecond knot156bor other tying configuration or device. The first andsecond pledgets158aand158bcan be other pressure diffusers known to one having ordinary skill in the art, such as thetoggles100 described infra and supra.
• FIGS. 45 and 46 illustrate atoggle deployment device159 that can be in a first retracted configuration. Thetoggle deployment device159 can have apressure check port160. Thepressure check port160 can be in fluid communication with a sensor or port on or near the handle (not shown) of thetoggle deployment device159, such as an external lumen where blood flow can be observed, for example from flow from the end of an external tube or port and/or through a transparent or translucent window. Thepressure check port160 can facilitate deployment of thetoggle deployment device159 to a location where thepressure check port160 is introduced to pressure, for example when thepressure check port160 enters thebiological lumen114. The sensor or port on or near the handle of thetoggle deployment device159 will signal that thepressure check port160 has been placed into the biological lumen114 (e.g., by displaying a small amount of blood flow). Thepressure check port160 can be deployed into thebiological lumen114 and then withdrawn from thebiological lumen114 to the point where thelumen wall116 just stops the pressure in thepressure check port160. The entrywall retainer port54 can additionally perform the function as described herein for thepressure check port160. Thetoggle deployment device159 can have adelivery needle port161.
• FIGS. 47 and 48 illustrate thetoggle deployment device159 that can be in a second delivery configuration. Adelivery needle162 can be slidably attached to thetoggle deployment device159. Thedelivery needle162 can egress from thedelivery needle port161 when thetoggle deployment device159 is in the second delivery configuration.
• FIGS. 49 and 50 illustrate that thetoggle deployment device159 can be deployed into thearteriotomy120 or128 at a location where thepressure check port160 can be located in thebiological lumen114. Thedelivery needle port161 can be in, or adjacent to, thelumen wall116.
• FIGS. 51 and 52 illustrate that thetoggle deployment device159 can be placed in the second delivery configuration. If the delivery needle port is in, or adjacent to, thelumen wall116 when thetoggle deployment device159 is placed in the second delivery configuration, thedelivery needle162 can enter thelumen wall116. For example, thedelivery needle162 can enter thesecond web142. Thedelivery needle162 can exit thesecond web142 and enter, as shown by arrows, thebiological lumen114.
• FIG. 53 illustrates that apusher164 can be slidably attached to thedelivery needle162. Thedelivery needle162 can have aneedle tip port166. Thetoggle100 can be in thedelivery needle162. Thetoggle100 can be configured in thedelivery needle162 such that the togglefirst end102 can be located on the needle tip port166-side of thepusher164.
• FIG. 54 illustrates that thepusher164 can be moved, as shown by arrow, toward theneedle tip port166. Thedelivery needle162 can be moved back relative to thepusher164, thepusher164 can be moved forward relative to thedelivery needle162, or combinations thereof. Thepusher164 can push the togglefirst end102 out of thedelivery needle162. Thepusher164 can push the togglefirst end102 into thebiological lumen114.
• FIGS. 55 and 56 illustrate that thetoggle deployment device159 can be in a first retracted configuration after deploying the togglefirst end102 into thebiological lumen114. When thedelivery needle162 retracts into thetoggle deployment device159, the togglesecond end104 can be in thetoggle deployment device159. Thefilament106 can extend though thedelivery needle port161.
• FIGS. 57 and 58 illustrate that thetoggle100 can be deployed across the lumen wall. When thetoggle deployment device159 is removed from the arteriotomy, the togglesecond end104 can deploy on the outside of thelumen wall116 from thedelivery needle port161. The togglefirst end102 can form an interference fit with thelumen wall surface118. The togglesecond end104 can form an interference fit with the outside of thelumen wall116 or the surrounding tissue, such as subcutaneous tissue. The togglesecond end104 can be slidably translated along thefilament106 toward thelumen wall116, for example for thetoggle100 illustrated inFIG. 20. The length of thefilament106 on the opposite side of togglesecond end104 from the togglefirst end102 can be cut, snapped, torn or otherwise removed.
• FIGS. 59 through 63 illustrate a method for deploying thetoggle100. Thedelivery needle162 can egress, as shown by arrow, from a toggledeployment delivery port163. The toggledeployment delivery port163 can be in thedelivery guide4. Thedelivery needle162′ can be advanced toward thelumen114.
• FIG. 60 illustrates that thedelivery needle162 can be deployed through the lumen wall. When thedelivery needle162 is deployed through thelumen wall116, the delivery needle can intersect, or pass adjacent to, the second arteriotomy.
• FIGS. 61 and 62 illustrate that thepusher164 can be advanced, as shown by arrow, through thedelivery needle162. The togglefirst end102 can egress from theneedle tip port166. The togglefirst end102 can deploy into thelumen114.
• FIG. 63 illustrates that thedelivery needle162 can be retracted into thedelivery guide4 and/or thefilament106 can be pulled taught, both shown by arrow. The togglefirst end102 can form an interference fit with thelumen wall surface118. The toggle second end104 (not shown inFIG. 63) can be slidably translated on thefilament106 down to, and form an interference fit with, the outside of thelumen wall116. The length of thefilament106 on the opposite side of togglesecond end104 from the togglefirst end102 can be cut, snapped, torn or otherwise removed.
• FIG. 64 illustrates anintroducer needle165 that can have an end inserted, as shown by arrow, through thelumen wall116 and into thelumen114, for example by using the Seldinger technique. Theintroducer needle165 can be hollow and/or have a longitudinal channel.FIG. 65 illustrates that theguidewire168 can be deployed, shown by arrows, through the hollow and/or longitudinal channel of theintroducer needle165.
• FIG. 66 illustrates that theintroducer needle165 can be removed, as shown by arrow, from thelumen wall116. Theguidewire168 can remain substantially in place. After theintroducer needle165 is removed, a portion of theguidewire168 can be outside thelumen114 and another portion of theguidewire168 can be inside thelumen114.
• FIG. 67 illustrates a method of fixedly or slidably attaching theguidewire168 to theanchor6. A guidewire proximal end.170 can be placed in proximity to an anchordistal end172. The guidewireproximal end170 can then be attached, as shown by arrows, to the anchordistal end172. The guidewireproximal end170 can be attached to the anchordistal end172 while some or all of theguidewire168 is in thelumen114. The guidewireproximal end170 can be configured to snap-fit, interference fit, slidably attach or combinations thereof, to theanchor6. When theguidewire168 is attached to theanchor6, theguidewire168 can act as theanchor extension section14 and/or the lumenal tool.FIG. 68 illustrates theguidewire168 attached to theanchor6.
• Where applicable, the methods described supra for deploying any supplemental closure device can be used for deploying any of the other supplementary deployment device. It is apparent to one skilled in the art that various changes and modifications can be made to this disclosure, and equivalents employed, without departing from the spirit and scope of the invention. Elements shown with any embodiment are exemplary for the specific embodiment and can be used on other embodiments within this disclosure.

Claims (20)

1-55. (canceled)

56: A device for forming a self-sealing opening in tissue comprising:

a first introducer for creating an opening through a tissue wall into a lumen of the tissue, wherein at least a portion of the first introducer is configured to locate an inner surface of the lumen wall; and

a second introducer for creating a substantially horizontal opening through the tissue wall, wherein the first introducer and second introducer are part of a single device.

57: The device ofclaim 56 wherein the first introducer comprises at least one needle.

58: The device ofclaim 57 wherein the first introducer further comprises at least one guide sheath or guidewire.

59: The device ofclaim 56 further comprising a delivery guide.

60: The device ofclaim 59 wherein the first introducer is slidably disposed within the delivery guide.

61: The device ofclaim 59 wherein the second introducer is slidably disposed within the delivery guide.

62: The device ofclaim 56 wherein the second introducer is configured to create a substantially horizontal opening through the tissue wall near the location of the tissue opening created by the first introducer.

63: The device ofclaim 56 wherein at least one of the first or second introducers comprises a lumen.

64: The device ofclaim 56 further comprising a retainer.

65: The device ofclaim 64 wherein the retainer is a luminal retainer, an entry wall retainer, or both.

66: The device ofclaim 56 wherein at least one of the first or second introducers has a preformed shape.

67: The device ofclaim 66 wherein the preformed shape comprises one or more bends.

68: A method for creating a self-sealing opening in a blood vessel comprising:

creating a substantially diagonal tract through a blood vessel wall, wherein the majority of the tract lies within the vessel wall and wherein blood pressure acting on the tract seals the opening.

69: The method ofclaim 68 wherein creating the tract comprises:

introducing a first introducer through the vessel wall into the lumen of the vessel wherein at least a portion of the first introducer is used to locate an inner surface of the lumen wall; and

introducing a second introducer substantially laterally through the vessel wall above the inner surface of the lumen wall, to create the majority of the tract.

70: The method ofclaim 69 further comprising delivering a drug within the lumen of vessel.

71: The method ofclaim 68 further comprising delivering a drug within the vessel wall.

72: The method ofclaim 68 wherein the vessel wall comprises intima, media, adventitia, or a combination thereof.

73: The method ofclaim 68 wherein at least one of the first or second introducers comprises a lumen and wherein the method further comprises introducing a guidewire through the lumen of the first or second introducers.

74: The method ofclaim 68 wherein the tract comprises at least two distinct segments.

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